ASCO: Survival no Better After Axillary Node Surgery

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ASCO: Survival No Better After Axillary Node Surgery

_http://www.breastcancer.org/treatment/surgery/new_research/20100608b.jsp_

(http://r20.rs6.net/tn.jsp?et=1103515208174 & s=535 & e=001a4A03Hucb0mpGyLUHUdSX1

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The three studies reviewed here suggest that routinely removing the

underarm (axillary) lymph nodes during early-stage breast cancer surgery may

not

make sense for most women. These results were presented at the 2010

American Society of Clinical Oncology (ASCO) annual meeting.

When early-stage breast cancer is removed, the lymph node closest to the

cancer -- called the sentinel node -- often is removed and sent to a

pathologist for evaluation. Removing just this one node is called sentinel node

biopsy or sentinel node dissection.

If cancer cells are in the sentinel node, it means the cancer has spread

beyond the breast. So more treatment may be needed to reduce the risk of the

cancer coming back (recurrence).

Treatment choices to reduce the risk of recurrence if cancer is in the

sentinel node include:

· removing other underarm lymph nodes (axillary node dissection)

· radiation therapy to the underarm lymph nodes (axillary

radiation)

· chemotherapy

· hormonal therapy if the cancer is hormone-receptor-positive

In the first study, 856 women diagnosed with early-stage breast cancer had:

· lumpectomy to remove the cancer

· cancer cells in the sentinel lymph node

· traditional whole-breast radiation therapy after surgery

After radiation, the women were split into two groups. One group had

axillary node dissection and the other group had no more surgery.

After about 6 years, the researchers found no differences in treatment

outcomes between the two groups:

· 92.5% of women who didn't have axillary node dissection were

alive after 5 years (called overall survival) compared to 91.9% of women who

had axillary node dissection

· 83.8% of the women who didn't have axillary node dissection

were alive with no cancer recurrence after 5 years (called progression-free

survival) compared to 82.2% of women who had axillary node dissection

· 2.1% of the women who didn't have axillary node dissection had

a cancer recurrence within 5 years compared to 3.7% of women who had

axillary node dissection

· 1.3% of women who didn't have axillary node dissection had

cancer come back in the lymph nodes compared to 0.6% of women who had axillary

node dissection

In the second study, almost 4,000 women had surgery to remove early-stage

breast cancer. None of the women had cancer cells in their lymph nodes. The

women were split into to groups. One group had axillary node dissection

and the other group had no more surgery.

After about 8 years of follow-up, the researchers found that overall

survival, disease-free survival, and the risk of recurrence were the same in bo

th groups. Still, the women who had axillary node dissection were more

likely to have shoulder and arm problems:

· 19% of women who had axillary node dissection had difficulty

rotating their shoulder outward on the side of the surgery compared to 13% of

women who didn't have axillary node dissection

· 28% of women who had axillary node dissection had arm lymphedema

(the affected arm was 5% or more larger than the unaffected arm) on the

same side as the surgery compared to 17% of women who didn't have axillary

node dissection

· 31% of women who had axillary node dissection had arm numbness

on the same side as the surgery compared to 8% of women who didn't have

axillary node dissection

These results suggest that if the sentinel node is negative, axillary node

dissection may not offer any more benefits and may increases the risk of

arm and shoulder problems. Most doctors don't routinely recommend axillary

node dissection in women diagnosed with early-stage breast cancer if the

sentinel node is negative. For doctors that still routinely recommend

axillary node dissection if the sentinel node is negative in women diagnosed

with

early-stage breast cancer, these results suggest that may not make sense.

Some women diagnosed with early-stage breast cancer have no signs of

cancer spread but later are diagnosed with metastatic breast cancer (cancer

that has spread to locations away from the breast, such as the bones, liver or

brain). So the third study was designed to see if a more sensitive test to

detect cancer cells in the lymph nodes or bone marrow might help better

predict prognosis. Being able to so could help a woman and her doctor make

more informed treatment choices.

All 5,539 women in the third study had:

· lumpectomy to remove early-stage breast cancer

· sentinel node biopsy and a bone marrow sample taken to look for

individual or tiny clumps of cancer cells (called micrometastases)

If the traditional way of looking for cancer cells in the sentinel lymph

nodend bone marrow (staining the samples and looking for cancer cells with

a microscope) found no cancer, the researchers used a newer and more

sophisticated method, called immune system assay or immunohistochemistry test

to

look at the sentinel node and bone marrow samples.

The traditional staining method found cancer in the sentinel node in 24%

of the women. The more sensitive immunohistochemistry test found cancer in

the sentinel node that staining didn't detect in another 10% of the women.

Still, this better detection of cancer in the sentinel node didn't help

predict which women were likely to survive after a breast cancer diagnosis.

The immunohistochemistry test found cancer in 3% of the bone marrow

samples. In these cases, the immunohistochemistry test did help predict which

women were likely to survive; women with cancer in their bone marrow were

less likely to survive.

These results suggest that the immunohistochemistry test may help

determine prognosis if it's used on bone marrow samples, but not sentinel node

samples.

If you've been diagnosed with early-stage breast cancer, sentinel node

biopsy may be done as part of your surgery. If cancer cells are found in the

sentinel node, your doctor will consider all the details of your situation,

including your age and the characteristics of the cancer (size, stage,

etc.) before recommending treatments to reduce the risk of the cancer coming

back. Axillary node dissection is one possibility.

The studies reviewed here suggest that axillary node dissection may not be

beneficial for many women. Still, each woman's situation is unique. For

some women, the advantages of axillary node dissection may outweigh the

risks. If your doctor recommends axillary node dissection, you may want to ask

about these studies and how the results may apply to your situation. With

the most up-to-date information, you and your doctor can make the best

decisions for YOU.

You can learn more by visiting the Breastcancer.org Lymph Node Removal

pages

Resources:

ASCO: Survival No Better After Axillary Node Surgery

_http://www.medpagetoday.com/MeetingCoverage/ASCO/20556_

(http://r20.rs6.net/tn.jsp?et=1103515208174 & s=535 & e=001a4A03Hucb0nshl64DXLEeGkmY\

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ACOSOG Z0011: A randomized trial of axillary node dissection in women with

clinical T1-2 N0 M0 breast cancer who have a positive sentinel node.

_http://abstract.asco.org/AbstView_74_47842.html_

(http://r20.rs6.net/tn.jsp?et=1103515208174 & s=535 & e=001a4A03Hucb0nsSeC1vjXS0xGM-\

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